Articles about diseases

Posts Tagged ‘women’

“Impact of the Addition of Carboplatin and/or Bevacizumab to Neoadjuvant Once-Per-Week Paclitaxel Followed by Dose-Dense Doxorubicin and Cyclophosphamide on Pathologic Complete Response Rates in Stage II to III Triple-Negative Breast Cancer: CALGB 40603 (Alliance)” was accepted as a rapid publication and published online this month by the Journal of Clinical Oncology. It will come out in print in September.

Because of its rapid growth rate, many women with triple-negative breast cancer receive chemotherapy to try to shrink it before undergoing surgery. With the standard treatment, the cancer is eliminated from the breast and lymph nodes in the armpit before surgery in about one third of women. This is referred to as a pathologic complete response (pCR). In patients who achieve pCR, the cancer is much less likely to come back, spread to other parts of the body, and cause the patient’s death than if the cancer survives the chemotherapy.

Sikov and his collaborators studied the addition of other drugs — carboplatin and/or bevacizumab — to the standard treatment regimen to see if they could increase response rates. More than 440 women from cancer centers across the country enrolled in this randomized clinical trial.

“Adding either of these medications significantly increased the percentage of women who achieved a pCR with the preoperative treatment. We hope that this means fewer women will relapse and die of their cancer, though the study is not large enough to prove this conclusively. Of the two agents we studied, we are more encouraged by the results from the addition of carboplatin, since it was associated with fewer and less concerning additional side effects than bevacizumab,” Sikov explains.

“More studies are planned to confirm the role of carboplatin in women with triple-negative breast cancer, and also to see if we can better identify which of these patients are most likely to benefit from its use. Until we have those results, medical oncologists who treat women with triple-negative breast cancer will have to decide whether the potential benefits of adding carboplatin outweigh its risks for each individual patient.”

Triple-negative breast cancer accounts for 15 to 20 percent of invasive breast cancers diagnosed in the United States each year, and is more common in younger women, African-Americans, Hispanics, and BRCA1-mutation carriers. With no identified characteristic molecular abnormalities that can be targeted with medication, the current standard of treatment is chemotherapy.

“Overall prognosis for women with this type of breast cancer remains inferior to that of other breast cancer subtypes, with higher risk of early relapse,” Sikov says.

In a survey of around 2,200 women, Cancer Research UK scientists at University College London (UCL) found that 64 per cent felt they fully understood the information given about overdiagnosis — the chance that screening will pick up cancers that would never have gone on to cause any harm — by the National breast screening programme.

Information about overdiagnosis has only been included in the NHS breast screening invitation leaflets since late 2013, meaning that overdiagnosis is likely to be a new concept for many people.

But despite uncertainty over the information they were given, intentions to attend breast screening remained high, with only seven per cent of women saying they would be less likely to attend screening after receiving the overdiagnosis information. On the other hand, four per cent of women said they would be more likely to attend screening after receiving the information.

Study author, Dr Jo Waller, a researcher at the Health Behaviour Research Centre at UCL, said: “While there is clearly room for improvement, the information leaflet does appear to help some women make a decision about whether or not to have breast screening.

“But the study found that many women still struggle to understand the balance of benefits and harms linked to breast screening, so we need to find better ways to communicate the risks as well as the benefits.”

Overdiagnosis happens because some breast cancers grow so slowly that it would take more than a lifetime for them to threaten a woman’s health. For every life that is saved through screening, researchers estimate that around three women will be overdiagnosed with breast cancer, although there is presently no way of telling the difference between life-threatening cancers and cancers that are overdiagnosed, either at diagnosis or after treatment.

Sara Hiom, Cancer Research UK’s director of early diagnosis, said: “We think it’s vitally important for women to have clear information about breast screening, the balance of benefits and harms and the fact that they could be diagnosed with and treated for a cancer that might not have caused them harm.

“We are committed to providing quality information that can help women understand the harms and benefits of breast screening, and research like this can help us refine the information we offer to be sure that it is as helpful and understandable as possible.

“The concept of overdiagnosis is still very new for a lot of women because it has only been included in the NHS leaflets for a year. We hope that over time, people’s understanding of this concept will increase as more and more women receive information explaining this risk of screening.

“Any woman invited for breast screening and worried about the risks of overdiagnosis can speak to our specialist cancer nurses on freephone 0808 800 4040.”

The findings, set out in the Journal of the National Cancer Institute, are based on the experience of more than 2,000 young women in England and Wales treated for the cancer over a period of more than 40 years.

Previous research has suggested that women with Hodgkin lymphoma who receive certain types of chemotherapy or radiotherapy are at increased risk of going through the menopause early — but there was insufficient information to provide patients with detailed advice.

But the new study, led by scientists at The Institute of Cancer Research, London, provides precise estimates of risk for women depending on which treatment types and doses they received and at what age — allowing doctors to give them detailed advice about their risks of future infertility.

The research was largely funded by Breakthrough Breast Cancer and involved researchers from across the UK at more than 50 universities and hospitals.

The research team followed-up 2,127 women who had been treated for Hodgkin lymphoma in England and Wales between 1960 and 2004, and who had been aged under 36 at the time. All had received treatment with chest radiotherapy, sometimes alongside other treatments.

Some 605 of the women in the study underwent non-surgical menopause before the age of 40. This was a large enough number for the researchers to estimate accurate risks of menopause at different ages, depending on the mixture and doses of treatments they received and the age they received them.

The researchers produced a risk table which could help improve the advice that clinicians are able to give to women who have undergone treatment for the disease. Several of the treatments caused a sharp increase in premature menopause risk.

For example, a woman who had received six or more cycles of a standard chemotherapy regimen in her late 20s, but without receiving radiotherapy to the pelvic area, had a chance of around 18 per cent of undergoing menopause by the age of 30, or 58 per cent by age 40.

Overall, risk of premature menopause was more than 20-fold raised after ovarian radiotherapy, and also after some specific chemotherapy regimens. Risk of menopause by age 40 was 81 per cent after receiving ovarian radiotherapy at an overall dose of 5 or more Grays, and up to 75 per cent after chemotherapy, depending on the type, although only one per cent after receiving a chemotherapy regimen called ABVD.

“Hodgkin lymphoma often affects younger women, and although fortunately most survive the disease, treatments including certain types of chemotherapy and pelvic radiotherapy can lead to premature menopause.

“We hope our study will help women to understand better, in consultation with their doctors, their risks of future infertility following treatment for this malignancy. By looking in a much larger group of women than previous studies of this type, we were able to produce age and treatment specific risk estimates that we hope will be of practical use to individual women. I’m extremely grateful to the patients and doctors who made it possible for us to produce this information.”